Esophageal reconstruction after oncological total laryngopharyngoesophagectomy

Algorithmic approach

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Abstract

Background: Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck-skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly. Methods: We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty-four men and one woman were included with a mean age of 54 (range, 41–72) years. Patients were grouped by reconstruction into the gastric pull-up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes. Results: The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow-up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44%, 4%, and 76%, respectively. There was no significant difference in the leakage (53.3%, 50.0%, 16.7%, and 50.0%, p =.581), stricture (6.7%, 0%, 0%, and 0%, p = 1.000), or successful swallowing (73.3%, 50.0%, 83.3%, and 100%, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively. Conclusions: The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.

Original languageEnglish
Pages (from-to)6-13
Number of pages8
JournalMicrosurgery
Volume39
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

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Deglutition
Stomach
Pathologic Constriction
Neck
Skin
Free Tissue Flaps
Thigh
Colon
N-(3-N-(benzyloxycarbonyl)amino-1-carboxypropyl)leucyl-O-methyltyrosine N-methylamide

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{781f80bc82954f4485d58ccf9b034102,
title = "Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach",
abstract = "Background: Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck-skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly. Methods: We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty-four men and one woman were included with a mean age of 54 (range, 41–72) years. Patients were grouped by reconstruction into the gastric pull-up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes. Results: The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow-up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44{\%}, 4{\%}, and 76{\%}, respectively. There was no significant difference in the leakage (53.3{\%}, 50.0{\%}, 16.7{\%}, and 50.0{\%}, p =.581), stricture (6.7{\%}, 0{\%}, 0{\%}, and 0{\%}, p = 1.000), or successful swallowing (73.3{\%}, 50.0{\%}, 83.3{\%}, and 100{\%}, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively. Conclusions: The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.",
author = "Chang, {Tzu Yen} and Jenn-Ren Hsiao and Wei-Ting Lee and Chun-Yen Ou and Yi-Ting Yen and Yau-Lin Tseng and Shin-Chen Pan and Shyh-Jou Shieh and Yao-Chou Lee",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/micr.30304",
language = "English",
volume = "39",
pages = "6--13",
journal = "Microsurgery",
issn = "0738-1085",
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TY - JOUR

T1 - Esophageal reconstruction after oncological total laryngopharyngoesophagectomy

T2 - Algorithmic approach

AU - Chang, Tzu Yen

AU - Hsiao, Jenn-Ren

AU - Lee, Wei-Ting

AU - Ou, Chun-Yen

AU - Yen, Yi-Ting

AU - Tseng, Yau-Lin

AU - Pan, Shin-Chen

AU - Shieh, Shyh-Jou

AU - Lee, Yao-Chou

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck-skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly. Methods: We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty-four men and one woman were included with a mean age of 54 (range, 41–72) years. Patients were grouped by reconstruction into the gastric pull-up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes. Results: The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow-up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44%, 4%, and 76%, respectively. There was no significant difference in the leakage (53.3%, 50.0%, 16.7%, and 50.0%, p =.581), stricture (6.7%, 0%, 0%, and 0%, p = 1.000), or successful swallowing (73.3%, 50.0%, 83.3%, and 100%, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively. Conclusions: The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.

AB - Background: Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck-skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly. Methods: We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty-four men and one woman were included with a mean age of 54 (range, 41–72) years. Patients were grouped by reconstruction into the gastric pull-up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes. Results: The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow-up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44%, 4%, and 76%, respectively. There was no significant difference in the leakage (53.3%, 50.0%, 16.7%, and 50.0%, p =.581), stricture (6.7%, 0%, 0%, and 0%, p = 1.000), or successful swallowing (73.3%, 50.0%, 83.3%, and 100%, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively. Conclusions: The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.

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U2 - 10.1002/micr.30304

DO - 10.1002/micr.30304

M3 - Article

VL - 39

SP - 6

EP - 13

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 1

ER -